Wiki IP dx code help!

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Michele1229

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Hello everyone.

I am hoping someone with inpatient coding experience can help us. We had a 70 year old patient who came for surgery due to some hardware and kyphosis issues. Came on 11/04. Ever since surgery the patient had issues with coming out of anesthesia and hypoxia. All was going relatively well so on 11/08 they were gonna discharge the patient but found per CT done that patient had pulmonary embolism. Because of this, the discharge was stopped and the IP stay continued until 11/15.
I have some people saying the principal dx code should be the pulmonary embolism and then the kyphosis code.
I have some people saying the kyphosis should be principal and then code the pulmonary embolism as as secondary code since it developed as a complication.
Anyone know which should be coded as the reason after study for the IP stay?
On the discharge it states:
Post op, patient was in good neurological and physical condition. It was felt he was ready for discharge but found to have continued oxygen requirement since surgery. Given prior O2 requirement a CT was performed. This showed pulmonary embolism so discharge was delayed.
Thanks!!
 
The reason for the surgery is for the hardware and kyphosis issues, which would be your primary dx. Based on your notes it seems like the patient developed the pulmonary embolism during her stay which would be a complication to the surgery. Primary dx would be the kyphosis issues secondary dx would be the pulmonary embolism.

CT showed pulmonary embolism so discharge was delayed. Pt did not have the condition when admitted for the surgery.
 
I agree with em2177--the PE will be a secondary diagnosis and not your principal because the full UHDDS definition for principal diagnosis says "that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care." I added emphasis to the part of the definition that shows how PE could not be principal since it developed after the surgery. I agree that it extended her stay, which fully justifies it as a secondary diagnosis with a POA indicator of N, but that isn't a principal diagnosis based on the UHDDS definition.
 
I concur with em2177 and krburke.

the full UHDDS definition for principal diagnosis says "that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care." :)
 
Except... The reason the stay was extended was the PE, so after study the longer admit is due to the discovery of the PE which will supersede the original admitting diagnosis. This is covered in several AHA Coding Clinics.
 
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